Credentialing & Privileging Specialist

A career at Community Health Centers offers a unique opportunity to join a team that makes a real impact in our community every day, by improving individuals' health while enhancing their quality of life. Top Reasons to Work at Community Health Centers No weekends for the majority of our centers, 10 Paid Holidays and early Fridays A great benefits package that includes healthcare coverage, paid time off, paid holidays, retirement plan, and more. Competitive compensation with advancement opportunities and tuition / training reimbursement. Awarded "Best and Brightest Companies to Work for in the Nation" for 5 consecutive years. Awarded "Top 100 Workplaces for Growing Families" by Orlando Sentinel. Modernized and attractive health centers, that patients love. Job Summary: Credentialing and Recredentialing Coordinate initial credentialing and recredentialing activities for physicians, nurse practitioners, physician assistants, dentists, behavioral health providers, pharmacists, other licensed practitioners, and other clinical staff. Verifies provider qualifications, licensure, certifications, education, training, and other required credentials for new and existing providers. Perform primary source verification in accordance with organizational policies and regulatory requirements. Monitors and manages the status of credentialing applications and requested information, applying proactive problem-solving regarding prioritization and follow-up of initial and reappointment applications. Sends timely notifications regarding upcoming expiration of appointments and credentialing requirements. Responsible for all verified information and prepares, presents, and maintains credential files for: VP/Chief Medical Officer, Specialty Chiefs, VP/Chief Dental Officer, and Associate Dental Director Board of Directors Other CHC departments as required Coordinates with providers to facilitate the hospital privilege initial appointment and reappointment process by specialty. Reviews and processes requests for changes in clinical privileges and staff status through the appropriate committees. Maintains accurate records of committee decisions and ensures updates are completed timely. Develops Provider Employment Agreements: Drafts, reviews, and finalizes Provider Employment Agreements in compliance with organizational policies and legal requirements. Executes initial agreements and manages the renewal process while maintaining accurate records and timelines. Compliance and Regulatory Oversight Develops and implements complex credentialing processes and procedures that require a high level of responsibility, attention to detail, and accountability. Exercises significant discretion, independent judgment, and decision-making authority in managing credentialing operations and ensuring compliance with organizational and regulatory requirements. Responsible for ensuring compliance with credentialing policies, regulatory standards, accreditation requirements, and organizational business operations. Reviews, manages, and maintains the confidentiality of sensitive information and materials, including adverse findings and Personally Identifiable Information (PII), ensuring compliance with privacy, security, and confidentiality requirements. Oversees and maintains background screening records of healthcare providers as required by the Agency for Health Care Administration (AHCA). Conducts ongoing monitoring of license status and state and federal sanctions for both contracted and non-contracted providers and clinical staff. Investigates discrepancies and ensures compliance requirements are met. As part of ongoing monitoring, checks Medicare, Medicaid, state exclusion lists, Florida suspended and ineligible providers, and medical board licensure status. Coordinates timely license and certification renewals for all clinical staff and verifies that renewed credentials meet applicable licensing requirements. Develops and implements recommendations for process and procedural improvements based on analysis, evaluation, and regulatory requirements. Provider Data Management Maintains accurate, complete, confidential provider and clinical staff credentialing records and files, including records of professional licenses, certifications, background screenings, committee actions, privilege changes, and renewal dates Manages credentialing databases, tracking systems, and documentation systems to ensure information is current and audit-ready. Ensures all credentialing, privileging, and reappointment documentation is completed, filed, and retained according to organizational policies and regulatory requirements. Manages the Basic Life Support (BLS) program, ensuring clinical staff maintain required certifications and credential documentation. Communication and Collaboration Serves as the primary liaison between providers, clinical staff, and external organizations to obtain, verify, and validate credentialing information. Exercises independent judgment in assessing the accuracy and completeness of submitted information and resolving discrepancies. Develops, analyzes, and summarizes reports for the Credentialing Committee, Executive Leadership, Chief Medical Officer, Specialty Chiefs, Chief Dental Officer, and Associate Dental Director. Coordinates and facilitates Credentialing Committee meetings, ensuring all agenda materials, meeting minutes and credentialing requirements are completed within established timelines. Acts as liaison between the Managed Care, Finance and Credentialing departments regarding provider background screenings, renewals, Business Tax Receipts, and employment separations. Disseminates credentialing and privileging information to internal departments as required. Collaborates with Providers, Clinical Leadership, Human Resources, Legal, Compliance, Managed Care, and Operations departments to support credentialing, privileging, and provider onboarding activities. Responsible for the Credentialing Department monthly expense report. Qualifications Education: High school degree required. Associate's degree preferred. Experience: Minimum of two (2) years' Credentialing and Privileging experience in a healthcare setting required. Provider enrollment/credentialing software required. Certifications/Licensure: Certified Provider Credentialing Specialist preferred. #J-18808-Ljbffr